Peptik Ülser Perforasyonunda Trombosit Endekslerinin Mortalite Üzerine Etkisi Var mı?

Abstract

Özet: Peptik ülser hastalığı (PUD), asite bağlı mide ve duodenumda submukoza veya muscularis propriaya uzanan ülseratif bir lezyondur. Peptik ülser perforasyonu (PUP), PUD olgularının % 2-10'unda gözlenen en yaygın ikinci komplikasyondur. Gereç ve yöntemler: Ocak 2010 - Aralık 2018 tarihleri arasında PUP tanısı ile ameliyat edilen 70 hastanın kayıtları retrospektif olarak incelendi. . Hastalar da preoperatif olarak bakılan kan da MPV, PDW, WBC Trombosit sayısı ve mortalite gelişip gelişmediği kaydedildi. Hastalar mortalite geliştirmeyenler (Grup 1) ve mortalite gelişen hastalar (Grup 2) olmak üzere iki gruba ayrıldı. Bulgular: 10 hastada (% 14.2) mortalite görüldü. Bu hastaların 5 tanesi kadın, 5 tanesi erkekti. Hastalar da mortalite postoperatif erken dönemde (6. saat ve 2. gün) görüldü. MPV ve PDW değerlerinde istatistiksel olarak anlamlı bir fark saptandı(sırasıyla p <0.015 ve p <0.015). Sonuç olarak; çalışmamızda preoperatif olarak bakılan yüksek MPV ve PDW değerlerinin PUP nedeniyle opere edilecek hastalarda mortaliteyi öngörmede kullanılabileceğini düşünmekteyiz. MPV ve PDW deki değişikliklerin perforasyona bağlı peritonite sekonder gelişen sespsis nedeniyle olabileceğini öngörmekteyiz.

Keywords

• peptik ülser perforasyonu
• ortalama trombosit hacmi
• cerrahi
• mortalite

Do Platelet Indices Have an Effect On Mortality in Peptic Ulcer Perforation?

Abstract

Abstract: Peptic ulcer disease (PUD) is an ulcerative lesion that extends to the submucosa or muscularis propria in the acid-induced stomach and duodenum. Peptic ulcer perforation (PUP) is the second-most common complication observed in 2%–10% of PUD cases. Material and methods: The records of 70 patients who were operated with a diagnosis of PUP between January 2010 and December 2018 were reviewed retrospectively. The mean platelet volume (MPV), platelet distribution width (PDW), white blood cell (WBC) count, and platelet count in the preoperative blood tests and at mortality were recorded in the patients. The patients were divided into two groups: those who did not develop mortality (Group 1) and those who developed mortality (Group 2). Results: Mortality was seen in 10 (14.2%) patients, of which five each were male and female. All patients who developed mortality did so in the early postoperative period (6th hour and 2nd day). There was a statistically significant difference in MPV and PDW values (p < 0.015 and p < 0.015, respectively). As a result, in our study, we think that preoperative high MPV and PDW values can be used to predict mortality in patients who will be operated for PUP. We anticipate that changes in MPV and PDW may be due to sepsis developed secondary to peritonitis due to perforation.

Keywords

• Peptic ulcer perforation
• mean platelet volume
• surgery
• mortality

References

1. 1. Brock, J., et al., Process of care and outcomes for elderly patients hospitalized with peptic ulcer disease: results from a quality improvement project. Jama, 2001. 286(16): p. 1985-1993. 2. Lewis, J.D., et al., Hospitalization and mortality rates from peptic ulcer disease and GI bleeding in the 1990s: relationship to sales of nonsteroidal anti-inflammatory drugs and acid suppression medications. The American journal of gastroenterology, 2002. 97(10): p. 2540-2549. 3. Behrman, S.W., Management of complicated peptic ulcer disease. Archives of surgery, 2005. 140(2): p. 201-208. 4. Møller, M., et al., Peptic Ulcer Perforation (PULP) trial group. Multicentre trial of a perioperative protocol to reduce mortality in patients with peptic ulcer perforation. Br J Surg, 2011. 98(6): p. 802-10. 5. Cheng, M., W. Li, and M. Cheung, Early outcome after emergency gastrectomy for complicated peptic ulcer disease. Hong Kong Med J, 2012. 18(4): p. 291-298. 6. Svanes, C., Trends in perforated peptic ulcer: incidence, etiology, treatment, and prognosis. World journal of surgery, 2000. 24(3): p. 277-283. 7. Wang, Y.R., J.E. Richter, and D.T. Dempsey, Trends and outcomes of hospitalizations for peptic ulcer disease in the United States, 1993 to 2006. Annals of surgery, 2010. 251(1): p. 51-58. 8. Bertleff, M.J. and J.F. Lange, Perforated peptic ulcer disease: a review of history and treatment. Digestive surgery, 2010. 27(3): p. 161-169. 9. Byrge, N., et al., Laparoscopic versus open repair of perforated gastroduodenal ulcer: a National Surgical Quality Improvement Program analysis. The American Journal of Surgery, 2013. 206(6): p. 957-963. 10. Thachil, J. Platelets in inflammatory disorders: a pathophysiological and clinical perspective. in Seminars in thrombosis and hemostasis. 2015. Thieme Medical Publishers. 11. Aktimur, R., et al., Mean platelet volume is a significant biomarker in the differential diagnosis of acute appendicitis. Inflammation and Cell Signaling, 2015. 2(2). 12. Bilgiç, I.C., et al., The association of elevated mean platelet volume with the outcome of acute mesenteric ischemia. Blood Coagulation & Fibrinolysis, 2015. 26(7): p. 727-730. 13. Zampieri, F.G., et al., An increase in mean platelet volume after admission is associated with higher mortality in critically ill patients. Annals of intensive care, 2014. 4(1): p. 20. 14. Becchi, C., et al., Mean platelet volume trend in sepsis: is it a useful parameter? Minerva anestesiologica, 2006. 72(9): p. 749-756. 15. Herve, P., et al., Pathobiology of pulmonary hypertension. The role of platelets and thrombosis. Clinics in chest medicine, 2001. 22(3): p. 451-458. 16. Zhang, Z., et al., Platelet indices are novel predictors of hospital mortality in intensive care unit patients. Journal of critical care, 2014. 29(5): p. 885. e1-885. e6. 17. Dinc, B., et al., New parameter in diagnosis of acute appendicitis: platelet distribution width. World Journal of Gastroenterology: WJG, 2015. 21(6): p. 1821. 18. Patrick, C.H. and J. Lazarchick, The effect of bacteremia on automated platelet measurements in neonates. American journal of clinical pathology, 1990. 93(3): p. 391-394. 19. Njoroge, S., et al., Tuesday, July 29, 2014. CLINICAL CHEMISTRY, 2014. 60(10): p. S83.